This is an excerpt from a white paper, produced in partnership between Cotiviti and RISE, that explores the opportunities and challenges that health care payers face over the next five years as they develop and implement a transition strategy.
The shift to digital quality measurement is underway and the deadline to achieve a digital-only state is fast approaching.
The Centers for Medicare & Medicaid Services (CMS) has set a goal for organizations to transition to digital measurement, using standardized interoperable data, for all its reporting programs by 2030. The National Committee for Quality Assurance (NCQA) has aligned with CMS’s national quality strategy and is shifting its Health Effectiveness Data and Information Set (HEDIS®) program from traditional to digital quality measurement.
Despite the push to transition to digital measurement, most health plans don’t have a strategy in place to get their organizations ready to support the new system. During a recent webinar of 300 health plan participants, Cotiviti asked attendees how many were ready to exchange data for quality use cases via Fast Healthcare Interoperability Resources (FHIR®) a standard that the federal government requires health plans use to exchange health care information between different computer systems. More than 70 percent of participants said they either didn’t have a plan in place to use FHIR or haven’t begun discussing the need for a plan.
Without the ability to exchange data in FHIR, the model chosen by CMS and NCQA, there is no digital measurement. So, plans must now get ready for the shift to digital.
Click here to download and read the entire white paper.